HomeMy WebLinkAbout1001 Akin Ave - Applications/Furnace - 12/26/2014Resend12-26-14;07:27AM; ;970-484-4448 # 15/ 17
City of
Fort Coltins
'Planning, Development&Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
f❑ emolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
6(21
Application # (g 41 Ja` 3�2
forofie use only
Date /0-963--1t]
Job Site Address (require
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Value of Construction (labor, materials, profit)
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Property Owner Na a
Address
City/State Zip
Phone
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Applicant Ndm
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Address
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City/State Zip
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Phone
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Contractor
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Address
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Clty/State Zip
P6 60 9'06a
Phone
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here Report
Sa/atuaumit Z q��bya//enn=cwm
Are you paying with your trust account?
*Yes ❑ No
Is this a residential or``commmercial project? Residential ❑ Commercial
If residential, is it Ingle Family Detach ❑Condo/townhome (single family attached) ❑Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Cl Medical office ❑ Office 13Retall
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No Iryes, you may need to contact H/storic A eiwblbn
If this is for a demolition permit, what year was the building constructed?
If prior to 1974, you W11Aad an asbestos assessment to submit w1 i thfsw0cadon.
Description of work
*If fawn sprinkler/back fiow preventer, must list licensed plumber. If Brst-time A/C, must list licensed electrician.
Subcontractors: Ust the companyname orOtyofFtCeldnsAcense
Vectiidan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above Information is complete and Correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: i f1 Signature
5 Date I